Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University <p>The Annals of Pakistan Institute of Medical Sciences (APIMS) is the Official quarterly and open access journal of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Pakistan. Previously two separate medical journals of this institute were being published, namely, JPIMS started from 1990 and the Journal of Surgery 1991. They were officially merged into one journal APIMS in 2005. Annals of PIMS is recognized by Pakistan Medical and Dental Council (PMDC),&nbsp;&nbsp;index in EBSCO Host &amp; Base from Germany.&nbsp;</p> en-US <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License"></a><br>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> (Prof. Tanwir Khaliq) (SZABMU) Tue, 31 Mar 2020 00:00:00 +0000 OJS 60 Acute High Dose Reprotoxic Effects of Bisphenol-A on the Testicles of Adult Rodents. <p><strong>Objectives:</strong> To evaluate the acute effects of high dose of bisphenol-A (BPA) induced in the testicles of adult rats.<br><strong>Methodology:</strong> An Experimental study was conducted at Anatomy Department, University of Health Sciences, Lahore, from January 2015 to December 2015.<br>Twelve adult Wistar albino rats were weighed and divided into three groups of four rats each. Group A (control) was given corn oil (2ml/kg/day). Group B (BPA-100) was given BPA 100mg/kg/day dissolved in corn oil (2ml/kg/day). Group C (BPA-200) was given BPA 200mg/kg/day dissolved in corn oil (2ml/kg/day). The animals were sacrificed on the 8th day after weighing. Testis were weighed and fixed in Buoin’s solution. Johnson scoring was done in H&amp;E stained slides. Basement membrane integrity was observed in PAS stained slides.<br><strong>Results:</strong> Group A rats showed normal parameters. Group B (BPA-100) showed a significant decrease in Johnson score and an increase in basement membrane disruption while the changes in body weight of animals and paired weight of testis was statistically insignificant. Group C (BPA 200) rats died within 3-4 days and the experiment was limited to two groups.<br><strong>Conclusion:</strong> The results of the present study indicate that a high dosage of Bisphenol A in rats causes significant disruption of the testicular histology and proves to be a significant reprotoxin even with a short duration of exposure.</p> Rabia Sajjad Toor, Kanwal Sharif, Hafiza Sadia Ahmed, Tahrim Ansar Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 19 May 2020 00:00:00 +0000 Vitamin d3 levels in patients of left ventricular hypertrophy in essential hypertension; a case control study <p><strong>Objective:</strong> Analysis of serum cholecalciferol in essential hypertension and its correlation with left ventricular hypertrophy (LVH).<br><strong>Methodology:</strong> This cross sectional study was conducted at Department of Medicine, Isra University, Hyderabad from September 2017 to March 2018. Hundred controls and Hundred diagnosed cases of essential hypertension with left ventricular hypertrophy were selected. LVH was estimated by echocardiography. Blood samples were centrifuged at 4000 rpm (10 minutes) to separate sera for biochemical estimation of serum cholecalciferol, serum calcium, serum phosphate and alkaline phosphatase. Statistical analysis was performed on statistical software (SPSS 22.0) and Microsoft excel. Continuous variables were presented as mean ± S.D as analysed by Student`s t-test. Statistical significance was taken at 95% confidence interval (P-value ≤0.05).<br><strong>Results:</strong> Serum cholecalciferol was low in cases 22.84±5.10 ng/dl compared to controls 47.09±7.65 ng/dl (p=0.0001). Mean ± SD interventricular septum and posterior wall thickness was noted as 12.39±1.82 mm in cases. Serum cholecalciferol revealed negative correlation with LVH (r= - 0.774, p=0.0001).<br><strong>Conclusion:</strong> Low serum cholecalciferol was found in the essential hypertension with left ventricular hypertrophy.</p> Samia Siddiqui, Sana Roshan, Mazahir Buriro, Arsalan Ahmed Uqaili, Kumayl Abbas Meghji Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Comparison of casting versus elastic nail for the treatment of pediatric tibial diaphyseal fractures <p>Objective: To assess outcomes of Titanium elastic nail (regarding radiologic union, a discrepancy of limb length, malalignment, pain and complications) in treating pediatric tibial fractures in comparison with the traditional Casting method.<br />Methodology: This randomized controlled trial study was conducted in Department of Orthopaedics, Shaikh Zayed Hospital, Lahore through emergency /Outdoor patient department from May 2018 to Feb 2019. The total number of patients were categorized into two groups, 14 each group. In Group A, patients underwent treatment by elastic nails and patients in group B, underwent treatment with cast method. Post op X-Rays (serial) were done and Leg length inequality, Malalignment, pain and radiological union were assessed radiologically. Follow up of the patients was done in the outpatient department of Orthopaedic department after 1,3 and 6 months. The comparison for this among both groups was done by using Chi-square test. P value ≤ 0.05 was considered significant.<br />Results: The mechanism of injury was statistically same in both groups, p-value &gt; 0.05. In group-A, 7(50.0%) cases had Transverse, 4(28.6%) had Oblique and 3(21.4%) cases had comminuted fracture while in group-B there were 5(35.7%) cases who had Transverse, 2(14.3%) had Spiral, 4(28.6%) cases had Oblique and 3(21.4%) cases had Comminuted fracture, p-value &gt; 0.05. In both groups, the leg length inequality, frequency of malalignment, pain severity and complications were statistically same, p-value was &gt; 0.05.<br />Conclusion: Similar outcomes of Titanium elastic intramedullary nailing as compared to cast application in terms of bone union, alignment and infection rates.</p> Muneeb Ur Rehman Niazi, Syed Wasif Ali Shah, Riaz Qadeer, Abdul Qadir, Zaigham Habib, Sunit Dahal, Usman Amjad Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Visceral leishmaniasis among children presenting with pancytopenia <p><strong>Background: </strong>Pancytopenia can result from either a failure of production of hematopoietic progenitors or peripheral destruction of a cellular element either due to infection, immune-mediated damage or hypersplenism. Visceral leishmaniasis (VL), one of the chronic parasitic diseases in the world that affects millions of people recently, leishmaniasis has been seen with increasing frequency in patients with Pancytopenia.<br><strong>Objective:</strong> To determine the frequency of visceral leishmaniasis among children presenting with pancytopenia at Pediatric Department, Azzd Jammu and Kashmir Medical College Muzaffarabad<br><strong>Methodology</strong> This cross sectional study was conducted at the Department of paeds SKBZ/ CMH, Muzaffarabad. The study duration was 6 months from June 2018 to December 2018. All children with pancytopenia either of gender were enrolled. After taking informed demographic information, all the cases underwent bone marrow sampling to assess the Visceral Leishmaniasis. All the data was collected by self-made proforma.<br><strong>Results:</strong> Total 75 patients were studied; their mean age of patients was 6.74±3.14 years. Males were in majority 67.69% and 32.31% were females. Leishmaniasis was found 15.38% of the cases. Leishmaniasis was statistically insignificant according to age and gender; p-values were quite insignificant.<br><strong>Conclusion:</strong> It is concluded that the visceral leishmaniasis in children with pancytopenia was 15.38%.</p> Khawaja Tahir Aziz, Naheem Ahmed, Muhammad Mateen Khan, Rashada Bibi , Abdul Rauf Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Contributing factors and their association with blood pressure control amongst hypertensive patients <p><strong>Objective:</strong> To assess contributing factors and their association with blood pressure control amongst hypertensive patients.<br><strong>Methodology:</strong> This cross sectional comparative study was conducted at OPD general medicine dept, Pakistan Institute of Medical Sciences, from July to December 2018. Hypertensive patients of both genders, having age more than 18 years, and on antihypertensive medication form at least six months were included in the study. Optimally controlled BP was defined as an average systolic BP &lt; 140 and diastolic BP &lt; 90 mmHg if the patient is younger than 60 years, or an average systolic BP &lt; 150 and diastolic BP &lt; 90mmHg if patient was older than 60 years. Logistic regression was applied to assess the effect of different factors on blood pressure control of the hypertensive patients.<br><strong>Results:</strong> In the study sample majority 107 (55.4%) of the patients belonged to 41-60 years age group, and females 106 (54.9%) were predominant. Main bulk 155 (80.3%) of the patients was married and mostly 80 (41.5%) patients had monthly income in the range of 25000-50000. About half 89 (46.1%) of the patients enrolled for the study were doing adequate physical activity. Optimized blood pressure was found in 92 (47.67%) patients.<br><strong>Conclusion:</strong> The proportion of hypertensive patients whose blood pressure was optimally controlled was relatively low and less than half of patients had blood pressure in acceptable limits. Age group (41-60) years, routine use of vegetable on most days of week, physical activity, adherence to treatment and taking less than three drugs have a strong relationship with blood pressure to keep in optimized limits.</p> Ghulam Mujtaba Nasir, Haroon Rashid Khan, Khuram Parvez, Juwayria Omar, Alishba Mukhtar Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Patterns of coronary artery vessel disease on diagnostic angiography in a south asian population <p><strong>Objective:</strong> The objective was to establish patterns of diseased vessels amongst the study population.<br><strong>Methodology:</strong> This retrospective descriptive study analyzed the data of 396 patients who underwent diagnostic angiographies at a large tertiary care public hospital in Islamabad, from January-2018 till October 2018. All data was coded and recorded in SPSS and was quantitatively run to find percentages and tests of significance were done.<br><strong>Results:</strong> We found that single vessel disease was the most common at 31.6%, and that the left anterior descending was the most commonly involved vessel with the most significant coronary artery disease, 86.6% and 71.4% respectively. <strong>Conclusion:</strong> Hypertension and diabetes has a great burden on our South Asian population and contribution to the development of coronary artery disease. Severe disease present in one vessel should alert physicians to the possibility of multi-vessel involvement and multi vessel progression in the disease progress.&nbsp; Delineation of the vessel involvement pattern in South Asians forms the basis for formulating local guidelines and strategies for tackling coronary artery disease.<br><strong>Keywords:</strong> Angiography, CAD, patterns.</p> Syed Nasir Ali Shah, Muhammad Ahmad, Vishal Farid Raza, Asad Riaz Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Diverse trends witnessed in assessing laryngeal lesions while comparing transcutaneous laryngeal ultrasound & videolaryngoscopy <p><strong>Objective: </strong>To determine the accuracy of Transcutaneous Laryngeal Ultrasound (TLUS) and Video Laryngoscopy (VL) taking Direct Laryngoscopy (DL) as Gold Standard for assessment of &nbsp;laryngeal pathologies.<br><strong>Methodology: </strong>This Cross Sectional Comparative clinical study recruited a sample of 24 cases of either gender, requiring laryngeal examination prospectively using convenience sampling from otolaryngology outpatients of Capital Hospital, Islamabad, Pakistan over a period of six months from 1<sup>st</sup> March, 2018 to 31<sup>st</sup> August, 2018. Patients fulfilling the selection criteria were subjected to Video Laryngoscopy under local anesthesia, Transcutaneous Laryngeal Ultrasound followed by Direct Laryngoscopy under general anesthesia and findings recorded.&nbsp; Data was analyzed using SPSS 23. Variables specially studied included Diagnostic values of both VDL and TLUS versus DL and presented with frequency, percentage, sensitivity, specificity, PPV and NPV and Accuracy Rate.<br><strong>Results: </strong>Study sample revealed 54.2% males and 45.8% females with mean age of 46.79 + 25.34 years. Hoarseness was commonest presentation (58.3%) and Laryngeal Polypi was the more frequent pathology noted (25%). VL had a sensitivity of 87.50%, specificity of 37.50%, PPV of 73.7%, NPV of 60% and Accuracy rate of 70.83%. While TLUS revealed a sensitivity of 43.80%, specificity of 70.80%, PPV of 100%, NPV of 47.15% and Accuracy rate of 62.50%.<br><strong>Conclusion:&nbsp;</strong>Video Laryngoscopy with a higher Accuracy and sensitivity compared to Transcutaneous Laryngeal Ultrasound, is more accurate examination for assessment of Laryngeal lesions.</p> Ghulam Saqulain, Abdul Aziz Khan Niazi, Nazia Mumtaz, Jawwad Ahmed Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Mon, 02 Mar 2020 00:00:00 +0000 Molecular Biology, A Revolutionary Science at Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad Sheikh Riazuddin Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Methotrexate drug plug and play role in Human body <p>MTX functionally acts as antimetabolite drugs, interfered folic acid metabolism, used as an anti-proliferative drug for abnormal cell growth inhibition such as tumor cell or cancer cell, chronic inflammation, ectopic pregnancy, psoriasis disease, multiple sclerosis disease, Crohn disease, sarcoidosis, rheumatology related disorder, and autoimmune disease. Newly synthesized MTX derivatives via organic Schiff base technique could be prepared, used against different disorder.</p> Muhammad Imran Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 impact of thyroid hormones on brain development <p>Thyroid hormones (THs) including triiodothyronine (T<sub>3</sub>) and tetraiodothyronine (T<sub>4</sub>) perform an essential role in brain development. The active form (T<sub>3</sub>) of THs is produced after metabolism and transported in different areas of brain. This actve form &nbsp;acts either by interacting with different types of glial cells or by mediating the expression of various genes for producing typical growth proteins. These protiens control many brain developmental processes such as synaptogenesis, neurogenesis, cell proliferation, differentiation, migration and maturation. During pregnancy the inadequate intake of iodine (I<sub>2</sub>) by pregnant mothers is associated with clinical manifestations because early brain development is totally dependent upon THs coming from maternal origin. A reduction in THs can alter these specific brain developmental processes, thereby changing the cognitive performance. On other hand THs supplementation can recover the normal circumstances.</p> Abdul Qader Hayat Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Giant esophageal leiomyoma and cardiac compression <p>Esophageal leiomyoma is rare diseases, it is often asymptomatic, and typically require only close surveillance except if became large and cause symptoms secondary to compression. We report a case with giant leiomyoma presented with chest pain and unstable blood pressure secondary to cardiac compression It is usually managed by thoracotomy and surgical enucleation and possible resection.</p> Sami Alnassar Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 Brown tumor of hyperparathyroidism Of anterior maxilla: case report <p>Hyperparathyroidism is characterized by the overproduction of parathyroid hormone (PTH). Hyperparathyroidism can be Primary, secondary and tertiary, In all these forms of hyperparathyroidism there is osteoclast mediated bone resorption which is caused by excess Parathyroid hormone levels that produce bone lesion called brown tumor of hyperparathyroidism. Brown tumor of Hyperparathyroidism is a benign non-odontogenic giant cell lesion of jaw with multinucleated giant cells. The term brown tumor is derived from the brown color of lesion as seen on surgical exploration. The characteristic discoloration is result of hemosiderin production. The brown tumor regress usually after hyperparathyroidism has been successfully corrected. Its surgical excision is usually not recommended until lesion is large symptomatic, at a risk of pathological fracture and recurrence. All the giant cell lesion are identical histologically and must be distinguished based on clinical, radiographic and biochemical means .Here we present a case of Brown tumor that reoccurred in 13 years old girl in anterior maxilla.</p> Jahangir Hammad, Farhat Gul Babar, Kashaf.ud.doja Tariq, Muhammad Ayoub Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000 An audit to evaluate the quantification of pleural effusions using thoracic ultrasonography in ICU setting at a tertiary care hospital. <p><strong>Objective:</strong>&nbsp; To develop a practical method of estimating the volume of pleural effusions with ultrasonography in ICU setting at a tertiary care hospital.<br><strong>Methodology:</strong> A clinical audit study was conducted at Department of Radiology, Jinnah Burn &amp; Reconstructive Surgery Center, Lahore, from December 2018 to August 2019. Scans of 21 patients who underwent ultrasonography for quantification of pleural effusions in the ICU in December 2018 were studied retrospectively to assess the parameters being followed in the first audit. <br><strong>Results:</strong> In the first audit, it was ascertained that the pleural effusion was being quantified into mild, moderate and severe based on subjective values. The method of quantification used was the same for supine and erect patients.&nbsp; The separation between two pleura was measures in mm and aspirated effusion in ml. A positive correlation was noted between these two measurements. The re-audit performed 6 months later showed improvement with 100% compliance to standards.<br><strong>Conclusion:</strong> The first audit revealed that the qualitative method was being used solely. The effusion was classified as minimal if the hypoechoic space was at the costophrenic angle only, small if it covered the costophrenic angle but limited within the image formed by the transducer, moderate if the space was larger than the image but limited within two images; and large or massive if it was larger than two images formed by the transducer. But being a qualitative classification, this did not give the amount of effusion in each category.</p> Sobia Mazhar Copyright (c) 2020 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Tue, 31 Mar 2020 00:00:00 +0000